Federation of Clinical Immunology Societies - FOCIS Member Society Application

FOCIS Member Society Application

Fields with a star (*) are required.

Formal Name of Society or Organization: *

Mission statement/primary objective: *

Approximate number of members: *

Classes of Membership: (ex: fellow, trainee member, junior member, etc.)

Membership in National or Multi-national bodies:

Certification, if available (e.g. national, European, international, larger societies):

Our organization is: *
for-profit
not-for-profit
other (please explain):

Please consider our organization for: *
Full Member Society Status (with voting rights)
Affiliate Member Society Status (without voting rights)

President/Chair:
Name: *
Designation:
Title:
Address: *

City: *
State: *
Zip/Postal Code: *
Country: *
Phone: *
Fax:
E-mail: *

Chief staff officer/main office contact:
Name: *
Designation:
Title:
Address: *

City: *
State: *
Zip/Postal Code: *
Country: *
Phone: *
Fax:
E-mail: *

Upcoming meetings (name and date/year):
1. *
2.
3.
4.

Other future activities/educational programs (name and date):
1.
2.
3.
4.

Recent Meeting History (date, location, number of attendees):
1. *
2.
3.

Please attach as a Word or PDF document: Roster of current officers, including address, telephone, fax and e-mail address Copy of current Constitution and/or Bylaws Letter of recommendation from FOCIS leader* (This leader can be a current or past FOCIS Chair, Vice Chair, Secretary/Treasurer, Committee Chair or Steering Committee Representative. For a list of FOCIS Leaders, please click here.) *Note: This letter can also be sent via post to: FOCIS Executive Office 11950 West Lake Park Dr. Suite 320 Milwaukee, WI 53224 If you need to make more attachments then space provides, please click here to send them as e-mail attachments. If you are attempting to upload files larger than 5 MB, please remove your attachments and click here to contact the FOCIS Executive Office.
Please click only once. Your attachments may take a minute to upload.